Healthcare Provider Details

I. General information

NPI: 1770900904
Provider Name (Legal Business Name): YAZMIN ENCHAUTEGUI COLON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE # 5D
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

920 STANTON L YOUNG BLVD # 2410
OKLAHOMA CITY OK
73104-5036
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4211
  • Fax: 405-271-2263
Mailing address:
  • Phone: 405-271-4211
  • Fax: 405-271-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18754
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberME129070
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberDR.0056958
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number35335
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: